JEE(Main) 2021

Confirmation Page

Application No. 210310184841 -

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Candidate's Name PRIYANSHU KUMAR Candidate Date of Birth 15-01-2003
Mother's Name SHIPRA DAYAL Category General
Father's Name RAJ KUMAR SINGH Gender Male
If you are a PwD Candidate, do you have No Nationality Indian
benchmark disability (40% or more /
“Severe” where percentage is not defined)
?
Place of Residence Urban State/ UT from where 12th/ JHARKHAND
Equivalent Passed/ Appearing
Are You Diabetic? NO Mode of Preparation Self Study
Medium of Schooling in Qualifying English
Examination

Applied For
Apply For B.E./B.Tech., B. Arch and B.Planning All Question Paper Medium English
Session(s) of Exam Apply For February, March, April, May Exam State/ City-1st choice JHARKHAND - BOKARO STEEL CITY
Exam State/ City-2nd choice JHARKHAND - DHANBAD Exam State/ City-3rd choice JHARKHAND - RANCHI
Exam State/ City-4th choice JHARKHAND - JAMSHEDPUR

Additional Details
Are you a Twin No

Present Address
Address SECTOR-1/C QR. NO-804, BOKARO STEEL CITY Locality
City/Town/Village BOKARO STEEL CITY Country India
State JHARKHAND District BOKARO
Pin Code 827001 Email Address shi********@yahoo.co.in
Mobile Number 898****744 Alternate Contact No. 8987621463

Fee Payment Details

Payment Mode: Pay through SBI Transaction ID: CHF3047677
Exam Fee: 5200 /- Date of Transaction: 25/12/2020 12:01:54
Fee Submitted On: 25/12/2020
DECLARATION
I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph (with 80% face without mask),Signature

IP Address : 157.35.234.64 Date of Downloading : 03/03/2021 05:19:20 PM